Association of Women Surgeons

Introduction

The first account of a mentoring relationship dates back to the days of the Trojan War when Odysseus asked a trusted friend named Mentor to oversee the education and development of his son while the father went to war. The word "mentoring" has since been attributed to an activity in which a "senior" person who has earned respect, prestige and power within her/his field, takes a "junior" person under the wing to teach, encourage and provide an extra push to ensure that junior individual's success. Ultimately, the success of the protégé may reflect on the senior person, further adding to her/his prestige.¹ The role of the mentor will vary according to if the mentee is a student, resident or a member of the faculty. The student may require active prompting and occasionally even pushing to encourage success. More senior mentees may need less direction and simply require guidance to achieve their goals. The mentor/mentee relationship, while occurring in a professional setting, is expected to go beyond simple professional boundaries.

Mentoring Relationships

Mentoring relationships or partnerships may be assigned by the institution (formal) or chosen by the individual (informal)² Institutionally assigned roles customarily assume the relationship to be a strictly professional one: the senior person ensures that the junior person completes institutional requirements, is progressing appropriately in his or her field of study and has the knowledge necessary to achieve career success.² Relationships chosen by the individual are more likely to involve a personal element in addition to professional guidance.³ Ragins et al ^4,5 found that protégés with informal mentors demonstrated superior career development, higher incomes and more promotions than protégés with formal mentors. This is an important issue because formal mentoring programs are being developed as part of emerging diversity initiatives, aimed at helping women break through gender-related barriers to advancement since it has been suggested that women's needs are hindered by lack of access to powerful mentors.⁶ Although some research suggests that high-ranking male mentors are less effective career sponsors for women than female mentors other evidence suggests that role models need not be female. In fact there is evidence that the most helpful mentors are male and that the best role models may be of either sex.⁶ However, the approach to mentoring women may need to be different from that for mentoring men since women often do better than men in collaborative ventures, but must be taught how to protect themselves from being exploited. Informal mentors are often also role models who can provide an example of how to integrate personal and professional life.

Mentors, whether formal or informal, are almost always senior persons within their fields. They are chosen specifically for their ability to use the power of their positions and experience to develop the careers of those less powerful and less experienced. A mentor has moved beyond preoccupation with self to foster the growth of a developing professional.²

Why is Mentorship Necessary?

Mentoring relationships are an important determinant in career success and advancement.4 Individuals with mentors receive more promotions, have higher income and report more career satisfaction than those lacking mentors. A 1991 study of mentor relationships in academic medicine found that women with mentors have more publications in peer reviewed journals, spend more time in research, and report greater career satisfaction.⁷

How To Choose a Mentor

While mentoring relationships may occasionally evolve spontaneously out of a common interest or goal, more frequently one partner has to take the initiative. For medical students the mentor may be a resident or faculty member but the selection criteria are similar. A good mentor will:

• Encourage and demonstrate confidence in a mentee.

• Recognize him/her as an individual and value her/him as a person.

• Ensure a supportive environment.

• Provide frequent feedback.

• Be willing to invest time in a mentee.

• Invite the mentee to social functions and national meetings.

• Assist the mentee with projects, papers and research

• Be generous with credit.

1. Medical Students

Familiarize yourself with the faculty and residents in your institution by researching departmental brochures, websites, CVs and by talking to other students and to the residents. For each potential mentor note the following:

• Publications

• Teaching awards

• Mentorship awards

• Clinical practice or area of expertise

• Research areas

• Interactions with peers and medical students during teaching conferences or on rounds.

A personal fit is important in a mentor since differences in values can seriously undermine a mentoring relationship. You will need to be able to identify with the attributes of your mentor. The workaholic mentor without any personal life may be a great advisor but not someone you wish to emulate. As your interests and priorities change so may your mentor.

2. Residents

In addition to all of the above, when selecting a mentor residents should take into consideration:

• Reputation of the faculty member within the institution and at a national level

• Research opportunities

• Publications

• Position on national committees and in professional organizations.

3. Faculty

Faculty should consider all of the above in choosing a mentor. Faculty may need to have more than one mentor as it is frequently difficult to find one person in the mentee's area of interest who is an outstanding teacher, clinician and researcher with the additional time to be a mentor. Choosing a mentor from outside the mentee's department is acceptable and may be an advantage in establishing interdepartmental projects.

The Mentorship Process

The process of mentoring can take many forms, including counseling, advising, facilitating introductions, providing constructive criticism of teaching, grant proposals, or a professional portfolio. Establishing a positive mentoring relationship is very much like establishing other valued human relationships in a number of respects. Both parties usually have a genuine desire to understand the values and expectations of the other person, and to respect and become sensitive to one another's feelings and needs. At the same time, mentoring relationships differ in an important way because they are professional in nature. The perceptions of both members of the relationship change as the mentee's performance evolves to new levels of competence under the mentor's guidance and support. Mentoring relationships mature over time therefore most people will identify more than one mentor in their careers.

Responsibilities of the Mentor

Mentors should set aside an hour for the first meeting with a mentee.

1. Mentoring Medical Students

If the mentee is a medical student, prior to the first meeting obtain a copy of:

• The student's CV

• The medical school curriculum and ascertain whether courses are mandatory or voluntary. Know which courses are graded and which are pass/fail. It will be helpful to have list of clerkship directors available for easy contact.

• Institutional policy on "away" electives

•  Previous grades for the student

•  If permissible a report from the Dean for Student Affairs including previous evaluations.

2. Mentoring Residents

If the mentee is a resident prior to the first meeting obtain a copy of:

• The resident's CV

• Evaluations from previous clinical rotations, if applicable

• ABSITE results

• Call schedule

• Institutional policies on family leave, moonlighting, resident supervision

• GME Committee Grievance Policy

• Program requirements for advisor/mentors and resident probation.

It is important to make sure you are familiar with recent ACGME guidelines with regard to work hours and the competency based curriculum and evaluation system.⁸

3. Mentoring Faculty

If the mentee is a member of the faculty prior to the first meeting obtain a copy of:

• The faculty member's CV

• The institution's promotion and tenure guidelines

•  His/her official job description to ensure that the expectations of the mentor, mentee and chairperson are aligned.

The First Meeting

Use this first meeting to get to know each other and set some ground rules:

• Establish mutual expectations and a commitment to confidentiality.

• Identify strengths and weaknesses on both sides. Do not be afraid to involve the assistance of a colleague if the mentee requires assistance or advice outside your area of expertise.

• Be flexible but insistent about meeting on a regular basis.

• Identify goals and priorities with an appropriate timeline. Goals could be categorized under the following headings: personal, clinical, education, research and financial. Plan to reassess each at least at quarterly intervals. While it is important to have both short and long-term goals these will need to be flexible as priorities and opportunities will change with time.

• Always be generous with credit and never see the mentee as a threat. As with others we teach, we want to see our students reach beyond us and our mentee's success is ultimately our success.³

As the mentoring relationship develops the mentor should acquire an understanding of the mentees needs and strengths and should:

• Ensure that a mentee is on committees, a member of relevant professional organizations and applies for appropriate workshops that will aid career development.

• Ensure that mentees are invited as guests to social functions and assisted in forming professional relationships both in the institution and at a regional or national level that may be of benefit for example in establishing a new inter departmental health program, a multidisciplinary teaching conference, collaborative research or a joint teaching curriculum.

• Research opportunities to fund medical student or resident attendance at National Meetings for example the American college of Surgeons Resident and Medical Student Programs. ⁹

• Identify awards for outstanding residents or medical students that will advance their careers. ^9,10

•  Actively seek assistance from other faculty members if a mentee is interested in an area that is outside the mentor's area of expertise.

• Evaluate each other at least annually.

• Start a promotion portfolio for faculty. Generally excellence must be achieved and documented in one of three major areas of endeavor: research, teaching, or clinical service. The areas reflected in the portfolio must be consistent with the allocations in the mentee's job description.

Responsibilities of the Mentee

The mentoring relationship is one of collaboration that should ultimately benefit both sides. The mentee should demonstrate:

• Eagerness to learn

• Seriousness in the relationship

• Flexibility and an understanding of the mentor's demanding schedule

• Confidentiality

• Be prompt for all appointments

• Ask for and provide feedback

• Respect the mentor and never forget the time and effort this person is taking to offer you a smoother path on the way to success.

A mentor is a unique individual to you: neither friend, nor colleague, but something of a combination of these and more. Because the relationship differs from those you have with others in your department, you may feel more relaxed and less constrained by professional protocol. This is acceptable to a point, but make certain that you respect the relationship.

Potential Problems

A mentee may not meet goals because of personal difficulties or external problems. The most common problems are time constraints, lack of funds, or lack of infrastructure. With assistance and guidance the mentee should learn to readjust priorities and say "no" to those distracting tasks that are not helpful towards advancement. Explore the option of outside grants from professional, specialty organizations and industry while planning towards NIH funding or consider joining forces with a colleague to improve the strength of a proposal.¹¹ It may be possible to "borrow" a colleague's resources in exchange for the mentee's expertise. Unhelpful or obstructive colleagues can be the most challenging problem. Occasionally it may be necessary to intervene on behalf of a mentee. Although the best way to solve the issue will almost always be by negotiation within the department or division, the equal opportunity counselors are often a great resource with regard to putting concerns in perspective, assisting with documentation if necessary and advising on relevant institutional grievance policies. Difficulties may arise because of the intensity of mentoring relationships. In particular, the potential for misunderstandings may discourage the development of mixed-gender partnerships.

Be aware that as the relationship evolves, and the mentee progresses along his or her career path, his or her needs may change in a direction that leads away from us. This can be an awkward time for both but we should consider this our success. Strategies to counter mentor time constraints include developing faculty mentor awards, revising promotion and tenure rules to require and reward mentoring, and including mentoring activities on curricula vitae. Many schools have created programs and resources to improve faculty mentoring.³

Conclusions

Contemporary mentoring presents challenges not faced by academic medicine's current leaders, most of whom were "groomed" by someone who was also a white male. The homogeneity of senior faculty contrasts sharply with the heterogeneity of students and young faculty, many of who present orientations unfamiliar to their potential mentors.³ It is particularly important for women who are senior faculty members to establish mentoring programs for women by enlisting the assistance of the dean and department heads and formally reporting on progress.³ Given the rapidly changing complexities of medicine and career building, advice applicable even five years ago may no longer be helpful. Thus, many chairs and senior faculty could use assistance in becoming effective "contemporary" mentors. Evaluating chairs and faculty on how well they meet their mentoring responsibilities can help assure that these responsibilities are taken seriously.³

Mentoring is a developmental stage in one's professional life. By becoming a mentor, we have the opportunity to leave a part of ourselves in everyone we mentor. Long after we have retired from the world of grants, publications, students and patients, our work will still be going on in those we have guided as a mentor.²

References

1. Dunnington, Gary L. "The Art of Mentoring" The American Journal of Surgery 171:604- 607 1996

3. Bickel J, Wara D, Atkinson BF, et al. "Increasing women's leadership in academic medicine: Report of the AAMC project implementation committee" Academic Medicine 77:1043-1061,2002

4. Ragins BR, Scandura TA. "The way we were: Gender and the termination of mentoring relationships." J Appl Psychol 82(6): 945-953,1997

5. Ragins  BR, Cotton JL. "Mentor functions and outcomes: A comparison of men and women in formal and informal mentoring relationships." J Appl Psychol 84(4):529-550, 1999

6. Ferris LE, Mackinnon SE, Mizgala CL et al. "Do Canadian female surgeons feel discriminated against as women?" Can Med Assoc J. 154(1):21-27, 1996

7. Levinson W, Kaufman K, Clark B, Tolle SW. "Mentors and role models for women in academic medicine." Western Journal of Medicine 154:423-426; 1991

8. ACGME  http://www.acgme.org/

10. Association Of Women Surgeons Career Development Resource available at http://www.womensurgeons.org/education/career.htm